Note: Completing this form creates no obligation for you or your group. It simply enables us to identify any contributions that arrive for your organization, ensures that you get paid for those contributions, and qualifies you for the benefits available only to registered groups (including free postage when you ship your coins).

Also, it can be awkward if a donor calls us to verify a whether your group's fundraiser is real, and we have to admit that we've never heard of you. Save yourself the embarrassment!

Group Name (ex. "Football Booster Club") (required)

Organization (ex. "Oak Grove H.S.") (required)

Address (required)

Address 2

City (required)

State (required)

ZIP Code(required)

Tax ID #

Contact Person (required)

Contact Email (required)

Contact phone (required)

Anticipated Start Date (required)
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Anticipated Completion Date (required)
MonthUnsureOngoingJanFebMarAprMayJunJulAugSepOctNovDecDayUnsureOngoing12345678910111213141516171819202122232425262728293031

Please have someone contact me ASAP
 By phone By email Either way is OK

Comments/Questions/Additional Info

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